ABORTING PREGNANCIES AND REMOVING TEETH: UNLICENSED HOSPITALS AND FAKE DOCTORS THRIVE WHILE RISKING LIVES.

Mistakes by trained health personnel can cause fatal results. Now imagine untrained and illiterate people diagnosing medical conditions; prescribing medicine, conducting abortions, or removing teeth. Our latest investigation uncovers a host of fake hospitals operating without any licensing, by men without any formal medical education, risking scores of lives. 

A PIJ investigation has uncovered many fake hospitals including Kwa-Ngoma pictured above situated at Limbuli in Mulanje

MILIMO CHITSULO and JOSEPHINE CHINELE

*Agnes was in dire danger. She bled for close to nine hours until she fainted. Luckily, for her, she gained consciousness although she remained bedridden for days. Earlier that day, she had complained of a toothache and decided to visit the nearby Kwa-Ngoma clinic. The ‘doctor’ there asked her to undergo a tooth extraction.

“He injected something in my mouth but there was no waiting time as it’s done at a normal hospital. He took something like a spanner and removed the tooth, using a lot of force,” Agnes told the Platform for Investigative Journalism (PIJ).

Then the ordeal started. “It was double the pain,” Agness gnashed. She recalled that the practitioner used bare hands throughout the procedure– without gloves. 

Unknown to Agness, and many others who go to Kwa-Ngoma, the clinic is one of the many illegal hospitals that have mushroomed across the country, risking the lives of many unsuspecting people while enriching people who should have no business providing health services. 

A string operation by PIJ has uncovered unregistered clinics operated by untrained personnel in the Mulanje district alone amid suggestions more exist. The clinics do not have formal names; known by pseudo names about their owners such as  Kwa-Matchini owned by Andrew Matchini and  Kwa-Ngoma owned by Hastings Ngoma) 

While some of the operations of the hospitals are mundane such as prescribing painkillers for patients suffering headaches, our undercover team has found instances where these medical facilities–for want of a better term–are even conducting complex operations such as abortions and tooth extractions which could lead to severe and fatal consequences.

To avoid such consequences, the medical profession is highly regulated with the law requiring practitioners to have licenses. 

The investigation raises questions about the role of oversight bodies such as the Ministry of Health (MoH) and the Medical Council of Malawi (MCM).

A PIJ string operation

On Saturday, October 19th, 2024, at around 11:05 am, our undercover reporters, posing as a couple seeking to terminate a two-months-old pregnancy,  arrived at Kwa-Ngoma, located 600 metres away from Limbuli trading centre, in Mulanje district. 

The ‘couple’ was quickly ushered into a small room with worn-out furniture; a wooden cabinet, a bare examination bed, a desk, and three chairs. Initially, Hastings Ngoma, the ‘clinician’ or ‘doctor’, appeared suspicious of the strange couple but after exchanging a few pleasantries, Ngoma became comfortable and started attending to his new patients.

As the reporters continue engaging the “doctor” in a conversation around abortion, he claims to have aborted pregnancies before, including one case involving a nine-month foetus. Many women, he says, are seeking his services.

“Many women whose husbands are in South Africa are coming here to  terminate pregnancies.  Minutes before your arrival I was on a call with another woman seeking the same,” Ngoma proudly explains.

Ngoma also reveals his methods for “safe abortions”: He says he uses medication (non-surgical) and Dilation and Curettage (D&C) to evacuate the foetus from the uterus. He says he also treats other pregnancy-related complications, particularly involving the uterus and claims to have terminated ‘countless’ and an overdue 10-months pregnancy.

Ngoma recommends a vacuum evacuation (which he says costs K20,000) but the undercover reporter says she prefers pills so Ngoma offers four yellow tables for pregnancy termination, charging a sum of K8,000. 

“Take one now and at the same time insert one,” he instructs.

The ‘abortion pills’ do not have any packaging— just folded in a Morphine information piece of paper with no documentation related to the drug’s dosage, expected side effects, and contraindications.

A Malaria prescription and test kit our undercover team pictured at Kwa-Ngoma fake hospital

Ngoma only advises the couple–our cover team– to report progress the next morning which the team does the following day; claiming heavy bleeding, dizziness, vomiting, and headache which he said was ‘normal’.

Hours later, the same PIJ undercover team arrived at Kwa-Matchini located about 600-700 metres from Limbuli trading centre. The team had been tipped off to yet another fake hospital – this one operated by Andrew Matchini. 

Kwa-Matchini clinic in Mulanje is operated by a person without any medical or clinical background

The clinic operates right inside Mr Matchini’s semi-detached compound houses. Inside, the room is dilapidated, thanks to termites but the lives of people, too, could be at even greater risk. A table inside has assorted medicines displayed at room temperature, and there are no visible pharmacy facilities. Our tip is that Mr Matchini, too, is not qualified to discharge any health services.

As our reporter presents illness, claiming she has body pains and recently vomited, Mr. Matchini immediately reaches for a Malaria Rapid Diagnostic Testing kit and swiftly conducts a test without clinical gloves on. 

As expected the results are negative, but Mr. Matchini prescribes–orally– magnesium (he is out of the drug so he recommends its purchase at a drugstore) and any ulcer medications as he suspects the undercover reporter has gastric ulcer problems. “Answers,” he pronounces it.

“I had Esomeprazole for ulcers. It's finished. I have sent someone to buy from Limbe so they will will be arriving in the evening,” he said.

PIJ proceeded to investigate other hospitals and shared the findings with MoH, MCM, and Mulanje District Health Office. 

The MCM confirmed that the six clinics identified in the PIJ investigation are not registered to conduct health services and confirmed in an interview that operating as a medical officer without a license contravenes Section 66 of the Medical Council Act and this is punishable by a fine, and one-year imprisonment.  

Reacting to our findings, both the Malawi Health Equity Network (MHEN), a health governance civil society watchdog, and the Parliamentary Committee on Health, an organ of parliament that has oversight over health services in the country, blamed the regulators for failing to do their job.

MEHN Executive Director, George Jobe called on the Medical Council to enhance its efforts in combating illegal facilities, suggesting the need to enhance its network of getting tips and also bring to book the culprits.

“So long as a health facility is illegal, it’s hazardous. There is no better health service they can be allowed to provide. If they are afraid to register with MCM, it means they don’t meet the requirements, don’t have qualified personnel to handle human beings and medicines thereby dishing out substandard and toxic services,” Jobe said.

He also blamed community members for aiding illegal hospitals, saying the public should also fight against the dangerous operations of fake hospitals.

Parliamentary Health Committee Chairperson, Dr Matthews Ngwale told PIJ, the committee will take up the matter with the Ministry of Health to ensure action is taken on the matter.

Confrontation  

When finally confronted about operating hospitals illegally, Matchini confirmed running the premises and previously being busted by police last month October but claimed he stopped the business after being fined K150,000 in court.  (Our undercover team visited his premises on October 19th, 2024)

Matchini refused to disclose the number of years he has operated the hospital. He, however, admitted to having been previously fined the same amount for similar crimes, suggesting both that he is a serial offender and also raising questions about whether the current sentences for offenses for illegal operations of health services are serving deterrence for possible offenders. 

 “I have done this business for a long time. But I’m no longer into it. The police arrested me and confiscated all my medicine last month (October). The issue was even in court, where I paid a K150,000 fine,” he said, sounding calm.

The Medical Council of Malawi disputes this version, saying it has not conducted any operation that led to any arrests in the area during the said period. The Council admitted perpetrator fines are not deterrent enough and are currently under review, with one possible amendment focussing on adjusting the spot fine to K500,000.

Matchini– who said he spent three nights in police custody following his arrest in 2018–claimed remorse and says he is now running a legitimate grocery business.

“I realized it was wrong as I had no license and was unqualified. I was exposed to clinical issues when I worked as a wound dresser at the estate for ten years. We will reopen once my son completes his nursing training and obtains a license,” he said.

Ngoma–the owner of Kwa-Ngoma simply declined ever operating a clinic. He said his premises were being referred to as a hospital because they were once occupied by Saha private clinic. Ngoma said he worked for the Saha Clinic as a cleaner but denies offering any services–a claim our undercover investigation proves is false as Ngoma treated our team and prescribed abortion drugs.

“People are just used to me from that time… my house is not fit for a health facility. They operated the clinic in front and I lived behind. Even the Medical Council told the previous occupant that the premises are not fit for a hospital; that’s why they moved away,” Ngoma said. 

In a separate interview, MCM Chief Executive Officer, Dr. Davie Zolowele while saying the organisation conducts routine inspections of the 2,500 registered clinics across the country, admitted struggling to completely curb the mushrooming of fake hospitals. 

“Per year, we target to reach a minimum of ten health districts. When we reach a district, we inspect every facility because we don’t want to miss anything. This year, as of September 30, we had done inspections in five districts translating to 578 facilities,” said Dr. Zolowele.

He revealed that the body had received tips on the existence of similar illegal clinics in the Salima and Machinga districts which he said the body was working on shutting down. He assured the public that the Council was not taking the matter lightly, citing one incident in which an employee of the council was physically assaulted during an operation to close down similar clinics.

“We have been told that there are even more of such clinics along the border districts with Mozambique but on the Malawian side. We may not be able to inspect all clinics so we rely on tips from the public to bust these quack clinics. Unfortunately, the communities aren’t aware,” he added.

(PIJ has learned that after MCM shut down one alleged illegal operator, the owners dragged the Council to court in a K40 Million lawsuit for alleged loss of business. The Council is contesting the lawsuit.)

On its part, the Pharmacy Medicines and Regulatory Authority (PMRA), which regulates the dispensing of medicines through the issuance of administration licenses, said it was not previously alerted to the operations of clandestine clinics that are administering various medicines.

 “If such malpractice does exist, it poses a great danger to the general public, considering that irrational use of medicines may result in other health complications which may even lead to loss of life,” said  PMRA Spokesperson, Joseph Josiah.

Josiah said monitoring the existence of illegal medicine administration is a joint mandate of all the health regulatory bodies such as MCM, Nurses Council of Malawi, and PMRA.

Health services access woes

Even after a horrible experience at Kwa-Ngoma that nearly cost Agnes her life, she and her family still go to the same hospital whenever they want treatment. 

The nearest public facility is at Mloza Health Centre and it's often congested making patients wait for long periods before they are treated. 

Coupled with a lack of public awareness of the existence and dangers of illegal hospitals and challenges in accessing public facilities which are free but often situated at long distances, most communities are turning to individuals posing as medical officers whom the communities have accepted as medical practitioners without any questions.  

Quizzed on the findings, the Ministry of Health admitted the country has fewer hospitals (MoH currently has 900 health posts across the country against 20 million population) and health personnel than demanded by population size but warned the public against turning to unregistered hospitals and fake practitioners.

“The facilities may not have everything for various reasons, but using shortcuts is hazardous. MoH facilities are safe as they have appropriate medicines, staff, and equipment,” spokesperson Adrian Chikumbe told PIJ.”

He said communities unhappy with services from public hospitals should report matters to a health ombudsman at the hospital, and said the ministry was embarking on public awareness campaigns to ensure communities are able to report suspicious activities.

This article was produced by the Platform for Investigative Journalism (PIJ), a non-profit centre for investigative journalism. PIJ promotes public interest journalism and accountability. If you have witnessed any suspicious health service operations contact the Medical Council of Malawi on its toll-free line: 0887379115 or 118 For feedback and news tips to PIJ, email: [email protected] or Call +265996169705